People living with human immunodeficiency virus (HIV) face an elevated risk of sudden cardiac death, according to new data published in the Journal of the American Heart Association.
“People living with HIV are already known to have a higher risk of heart attack, stroke, heart failure, blood clots in the lungs and peripheral artery disease,” lead author Matthew S. Freiberg, MD, MSc, a cardiology chair and professor of medicine at Vanderbilt University School of Medicine in Nashville, Tennessee, said in a press release. “We know that among people with HIV, those who have a compromised immune system, for example a low total CD4+ T cell count, they seem to have a higher risk of cardiovascular disease than those who have high CD4+ T cell counts. It is unclear if a compromised immune system is a risk factor for sudden cardiac death.”
The authors reviewed data from more than 120,000 U.S. veterans. Data came from the Veteran Aging Cohort Study, an ongoing study that follows veterans with and without HIV. Participants entered the study on or after April 2003, and were followed through Dec. 31, 2014.
Overall, 30% of veterans included in the analysis were diagnosed with HIV. They were evaluated at hospitals all over the country. The average patient age was 50 years old. Ninety-seven percent were male, and 47% were Black.
Veterans living with HIV had a 14% higher risk of sudden cardiac death than veterans who did not have HIV. Also, the authors found that the increased risk of sudden cardiac death was 57% to 70% higher in veterans who had high viral loads of HIV and 50% higher for each additional heart disease risk factor.
The authors found that during a median follow-up of nine years, sudden cardiac death was indicated as the cause of death for 3,035 of the veterans. Of that group, 26% were diagnosed with HIV.
After adjusting for numerous risk factors, the authors found the risk of sudden cardiac death was ...
- not higher in people with HIV who had healthy levels of infection-fighting CD4+ T cells or among those who had a low level of the HIV virus in their blood;
- progressively higher with each risk factor for sudden cardiac death that was present, including existing cardiovascular disease, high blood pressure, smoking, hepatitis C infection, anemia, alcohol dependence or abuse, and chronic obstructive pulmonary disease, regardless of whether or not they had HIV;
- 70% higher in people with HIV whose blood tests showed that antiretroviral therapy had not suppressed the HIV viral load in their blood over time.
“Addressing risk factors related to both cardiovascular disease and HIV is essential to prevent the higher rates of sudden cardiac death in people with HIV,” Zian H. Tseng, MD, MAS, professor of medicine in residence at the University of California, San Francisco, said in the same press release. “Clinicians should consider screening for specific warning signs of sudden cardiac death such as fainting or heart palpitations. And, if indicated, clinicians should request additional testing such as echocardiograms or continuous rhythm monitoring.”
The authors noted that the results from this male-dominated sample of study participants may not be generalizable to women. Another limitation was that autopsies, the definitive way to diagnose sudden cardiac death, were rarely available.
The full analysis can be read here.